Body Fluids #1

1.Kidneys
2.Ureters
3.Bladder
4.Urethea

1.Paired organ system

2.Each divided into an outer cortext and inner medulla

3.One million nephrons

The basic microscopic structural and functional unit

Included:
1. Glomerulus
2. Proximal convuluted tubule
3. Descending and ascending loops of Henle
4. Distal convuluted tubule
5. Collecting ducts

Is a capillary network responsible for the filtration of blood

Is surrounded by Bowman's capsule

Is afferent (blood enters) and efferent (blodd away)

Is the primary site of reabsorption of essential constituents.

Is the closests to Bowman's capsule

Filtrate back into the blood

Water and electrolyte exchange here

Where concentration of urine begins

Where final concentration and secretion takes place

Renal artery

Afferent arteriole

Efferent Arteriole

Efferent Arteriole

1200ml/min or 120mL filtered a day

Renal blood pressure +/blood

Renin-angiotension-aldersterone (RAA) system

Sodium reabsorption-->Blood is now more concentrated

A hormone that triggers angiotension, which triggers aldersterone

Squeezes vessels to add more pressure

Causes kidneys to suck in more sodoium

An increase in blood pressure and volume occur after these to substances mix

Glomerular filtration

Blood cells and protein. It creates a protein-free ultrafiltrate

120 ml/min (170-190 L of fluid per day)

The return of certain constituents from the filtrate back into the blood

Proximal Convuluted tubule is the primary site in this

Some substances (glucose, amino acids) are completely reabsorped while others (H2O, Na, Cl) are reabsorbed according to the body's need at the time (electrolytes)

Active transport

Passive transport

The plasma concentration of a substance at which reabsorption stops and the subst6ance begins to appear in urine

Normal range: 75-100mg

160-180mg

The passage of substances from the blood into the tubular filtrate

Removes large unfilterable waste and excretes H ions for maintenance of blood acid-base balance

Final reabsorption of water

Begins in the distal convoluted tubule and continues in collecting ducts

The body's state of hydration

Antidiuretic Hormone (ADH) (reatains urine)

1. Removes waste products

2. Retention (retains?) of nutrients and essential compounds

3. Acid-base balance

4. Water balance

5. Hormone synthesis (renin, erythropoitin, Vitamin D)

Dietary intake, physical activity, body metabolism, age, and hormones

The endproduct of protein metabolism and is the #1 waste product. Able to pass though the glomerulus b/c it was smaller than protein

End product of purine metabolism

The endproduct of muscle metabolism

Chloride, sodium, and pottassium

RBCs, WBCs, epithilial cells, casts, crystals, bacteria

600-2000ml/day; 1500ml/day average

Decreased urine output

Lack (cessastion, stopped) of urine output

Increased output

Painful flow

Increased output of urine at night

1. To aid in the diagnosis of disease

2. To screen population for asymptomatice, congenital, or hereditary diseases (to monitor wellness)

3. To monitor the progress of disease

4. To monitor the effectiveness or complications of thereapy

Color, clarity, and specific gravity

1. Screen using reagent strips

2. Confirm positive reaction with other chemical tests

3. Indicate the likelihood or certain finding in the microscopic

Aids in the confirmation of kidney and urinary tract diseases

Urochrome

Color of urine due to dilute urine, or diabetes mellitus

Color of urine due to:
a. Concentrated urine (1st morning urine is more concentrated)
b. Dehydration

Color of urine is due to:
a. Bilirubin (liver disease)
b. Look for yellow foam

Color of urine is due to: pyridium, a drug

Color of urine is due to:
a. Bilirubin or biliverdin (breakdown product or hemoglobin)

Color of urine is due to: Intact RBCs (hematuria)

Color of urine is due to:
a. Hemoglobin (from lysed RBCs/hemoglobmuria)
b. Myoglobin (from muscle trauma)

Color of urine is due to: Porphyrins (intermediate products in producting of heme. Rare

Color of urine is due to: Melanin or homogentisic acid. Rare

Hematuria

Breakdown products of hemoglobin

Lysed red blood cells

Muscle trauma (crash, heart attack)

Intermediate products in production of heme

A clear container

Clear.

1st morning specimen

Transparent/ no visible particulates

Few particulates

Print is blurred through urine

Print not seen through urine

May precipitate or clot

1. Mucus
2. Talcs, creams
3. Fecal contamination
4. Sperm
5. Crystals
6. Squamous epithelial cells
7. Dyes

1. Red cells
2. White cells
3. Bacteria, yeast, trichomonas
4. Renal epithelial cells
5. Crystals
6. Lipids

The density of a solution compared witht he density of an equal volume of pure water. It is influenced by size and number of particles

It measures dissolved substances present in a solution and reflects the hydration of the patient

1.000

1.003-1.035

Dehydration

Hydration

Diseased kidneys. They lose their ability to concentrate +/or dilute urine and the SG becomes fixed.

Refractive index

A comparison of the VELOCITY of light in the AIR with the velocity of light in a SOLUTION

Dependent on teh concentration of dissolved particles present in the sample and determines the angle at which ligh passes through a solution

Refractometer

Multiply only the decimal protion (.035) by 2 (the dilution factor)
EXAMPLE: .035 x 2 = .07
.07 + 1.000 = 1.007

The frequency of a sound wave entering a solution will change in proportion to the density of the solution. Changes in sound waves are converted to Specific gravity by a MICROPROSESSOR

Creates a thirsty sensation

Diabetes insipidus, and high water intake

1. Proteinuria
2. Diabetes mellitus w/ glycosuria
3. Dehydration (fever, vomiting)
4. RADIOGRAPHIC DYES
5. High molecular weigh IZV solutions

Chronic renal disorder. Lost the ability to reabsorb.

Urea, Uric acid, and Creatinine

1. Do not touch pads with hands

2. Dip completely into WEL MIXED urine.

3. Remove excess urine by running edge of strip along the top of the container

4. Hold strip horizontally to avoid run-over from adjacent pads.

5. Compare color development to manufacturer's chart AT THE PROPER TIME

6. The intensity of the color formed is generally proportional to the amount of chemical present

1. Improving reproducibility
2. Improving color discrimination

Utilizes reflectance photometry

As intensity of color increases, reflection decreases

The biggest variable among lab personnel when performing D.S. analysis is in the interpretations of the color reactions

Correlate dipstick findings to each other, and to the physical and microscopic results

Lungs and kidneys

Kidneys

4.5-8.0

1. Starvation
2. Diabetet mellitus
3. Respiratory disease
4. High protein diets
5. Meds

1. Vomiting
2. UTI (bacteria convert urea to ammonia)
3. Vegetarians and dairy
4. Improperly stored urine (pH >9.0 and bacteria is present)

pH

Methyl red measures acid, brothymol blue measure alkaline

None, Unless urine has been improperly stored.

A protein POSITIVE urine is the most indicative of RENAL DISEASE

Less than 10 mg/dl or less than 100 mg/24hours

Albumin

Albumin

1. Pre-renal proteinuria (not yet in kidney)

2. Renal Proteinuria (in the kidney)

3. Post-renal proteinuria (kidney and urethra not the problem)

Acute phase reactants and
Bence Jones Proteins which may not be detected by routine urinalysis

Multiple Myeloma

Glomerular disorders or damage by toxins and

Diabetic nephropathy (renal disease)

Albumnin levels are too low to detect on a dipstick. (small amounts passed through)

Characteristic of early problems associates with diabetes.

Requires a more sensitive method than a dipstick for detection

*Glomerular disorders or damage by toxins
*Diabetic nephropathy (renal disease)
*Pre-eclampsia
*Tubular Disorders due to trauma, or chemicals
*Transient- small amounts of urine protein in normal persons associated with fever, or exercise

Albumnin levels are too low to detect on a dipstick. (small amounts passed through)

Characteristic of early problems associates with diabetes.

Requires a more sensitive method than a dipstick for detection

Occurs in renal proteinuria. Protein appears when a person is in an upright position, but disappears after lying down due to pressure on the renal artery. Benign. Usually disappears with age

Lower UTIs
Injury/trauma
Mentrual contamination

Protein

Protein alters the color

Albumin on the dipstick

1. Highly alkaline urine-check pH

2. Bacteria and cells contain protein and make it seem positive

The presense of proteins other than albumin (Bence Jones Proteins)

If D.S reads more than a trace, use Sulfosalicylic acid ppt (SSA)

Confirmatory tesing for protein.

*It reacts with ALL proteins
*Urine must be centrifuged to remove turbidity
*Mix equal parts urine and SSA
*Grade precipitation as compared to standards

*Radiographic dyes
*Drugs. Do a microscopic exam and look for DYE o drug crystals

Suspect something OTHER than albumin.

Perhaps dye crystals or Bence Jones Proteins

The frequent chemical analysis performed on urine

Proximal convoluted tubule. Because of this filteration, urine contains zero to minute amounts of glucose

When the blood level glucose becomes so elevated (hyperglycemia)that tubular reabsorption capability has been exceeded, glucose will appear in urine

*Diabetes mellitus (RT is 160-180 mg/dl
*Impaired tubular reabsorption
*Following ingestion of large amounts of sugar
*Gestational diabetes
*Hormone disorders that work in opposition to insulin

Glucose

Ascorbic acid (vitamin C)
Unpreserved specimens allowing glycolysis

Glucose and will not detect other sugars

If D.S. is positive for glucose OR if another sugar is suspected in the urine

*Clinitest or Benedict's Reaction (All sugars)

*Based on ability of sugars to reduce copper sulfate to curpous oxide

*Positive for ALL sugars but NOT as senstivei as the dipstick

An enzyme defect. Causes retardation, failure to thrive, and death in newborns. Screen kids less that 2 years old

By products of fat metabolism such as: Acetone, Acetoacetic acid, and Beta-hydroxybutyric acid

When large amounts of body fat is metablolized for energy

1. Low carb diets
2. Diabetes mellitus-ketones indicates a difencieny in insulin. Increased levels lead to acidosis.
3. Starvation or dieting
4. Vomiting
5. Strenuous exercise

Sodium nitroprusside reaction

Pigmented urine (drugs, meds, dyes)

Evaportation due to improperly stored urine

Acetest. A tablet test

Always clinically significant

1. Hematuria
2. Hemoglobinuria
3. Myoglobinuria

The presense of intact RBCs
*Urine is red and hazy/cloudy
*Trauma or injury
*Kidney stones
*Tumors
*Glomerulonephritis (infection in kidney)

The presense of hemoglobin causing a CLEAR, red urine
*Intravascular hemolysis in transfusion reaction, hemolytic anemias and severe burns

The presense of the muscle protein myoglobin
*Causes clear RED BROWN urine. NO red cells will be seen
*Crush
*AMI
*Strentuous exercise
*Muscle wasting disease
*Confirmed with special testing

Peroxidase enzyme will oxidize peroxide in the pad to cause a color change
*Free hemoglobin or myoglobin causes a uniform color reaction

*INTACT red cells cause a SPECKLED pattern on the pad

Menstrual contamination (nonpathological)

Bacterial enzymes found in UTIs

High specific gravity when crenated cells are present

Degradation product of hemoglobin. Normally metabolized in the LIVER

Urobilinogen which is excreted in feces and urine

No

Conjugated (direct) bilirubin in the urine

A vivid yellow pigment. A large amount of yellow foam is produced when shaken

*Hepatitis
*Cirrhosis and other liver disorders
*Bililary obstruction

*Pale stool = positive for bilirubin

Diazo reaction
Bilirubin reacts with diazonium salt to produce a color

Pigments from drugs or dyes

Exposure to light beacause bilirubin breakdowns in light

Ictotest. More sensitive than the dipstck and less affected by interfering substances. Produces a shaper color reaction

A normal by-product or RBC degradation. Formed by the REDUCTION of bilirubin by backterial enzymes in the intestines

*Excreted in both the feces and urine

Less than 1mg/dL or EHRLICH UNIT

*Liver diseases
*Hemolytic disorder, hemolytic anemias and intravascular hemolysis
*Biliary obstruction will cause a DECREASED level

Ehrlich-->cherry red color

Presence of other Ehrlich reacting compounds

Pigments

Improper storage=>light sensitive and exposure

Bacteria and may help detect cystitis in asymptomatic patients

Does NOT replace urine culture for testing UTIs

Bacteria in urine (not all) that produces the enzyme reductase can convert nitrate to nitrite

bladder infection

Kidney infection

Monitor patiens at high risk for UTIs and evaluates anitibiotic therapy

Griess test

Aromatice amine

Unpreserved urine may allow bacterial growth

*Not all bacteria produce UTIs
*Lack of dietary nitrates in veggies
*Urine not held in bladder long enough

Indicates the esterase released from WBCs in the urine. Indicates INFECTION OF INFLAMMATION in the urinary tract

*Dipstick is (+) during intact or lysed WBCs

*UTI-bacteria plus WBC
*Infection with trichomonas, Chlamydia, or yeast
*Inflammation-WBC WITHOUT bacterial infection

Esterase enzymes shown in granulocytic WBCs hydrolze an acid ester in the pad

Rare

High levels of glucose, protein, and high SG

High pH, +/-nitrite, Infection with trichomonas

Density in the urine based on size and # of dissolved particles present

A polyelectrolyte in the pad interacts with IONS in the urine sample

Ionizable substances

Glucose and radiographic dyes

Glusse and radiographic dyes

High levels of protein

Urine pH of 6.5 or lower

Small amount or white foam when shaken

Abundant white foam

Vivid yellow foam

Faintly aromatic

Staong unpleasant odor/foul

Sweet ot fruity due to the presence of ketones

Maple syrup